American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with resected stage II and stage III disease, what has a proven role in treatment?

1. Adjuvant chemotherapy

2. Only radiation therapy

3. Watchful waiting

4. Experimental treatments

The correct answer is: Adjuvant chemotherapy

In patients with resected stage II and stage III cancer, adjuvant chemotherapy has a well-established role in post-operative treatment. This systemic therapy aims to eliminate any residual microscopic disease and reduce the risk of recurrence after surgical intervention. The use of adjuvant chemotherapy is supported by numerous clinical trials that have shown a significant improvement in overall survival and disease-free survival in patients with these stages of cancer who receive such treatment. The rationale is that stage II and III cancers often carry a higher risk of metastasis, and addressing potential residual cancer cells with chemotherapy can lead to better long-term outcomes. Other treatment options like radiation therapy may play a role in specific circumstances, such as localized disease, but they are not universally accepted as the primary post-surgical intervention for all patients with stage II and III disease. Watchful waiting typically applies to less aggressive cancers in certain contexts rather than in patients with higher-stage cancers. Experimental treatments may be appropriate in trial settings but do not yet have the established efficacy seen with adjuvant chemotherapy for these stages.